Patients' inability to perform a preoperative cardiopulmonary exercise test or demonstrate an anaerobic threshold is associated with inferior outcomes after major colorectal surgery.

BACKGROUND: Surgical patients with poor functional capacity, determined by oxygen consumption at anaerobic threshold (AT) during cardiopulmonary exercise testing (CPET), experience longer hospital stays and worse short- and medium-term survival. However, previous studies excluded patients who were unable to perform a CPET or who failed to demonstrate an AT. We hypothesized that such patients are at risk of inferior outcomes after elective surgery. METHODS: All patients undergoing major colorectal surgery attempted CPET to assist in the planning of care. Patients were stratified by their test results into Fit (AT ≥ 11.0 ml O2 kg(-1) min(-1)), Unfit (AT < 11.0 ml O2 kg(-1) min(-1)), or Unable to CPET groups (failed to pedal or demonstrate an AT). For each group, we determined hospital stay and mortality. RESULTS: Between March 2009 and April 2010, 269 consecutive patients were screened, and proceeded to bowel resection. Median hospital stay was 8 days (IQR 5.1-13.4) and there were 44 deaths (16%) at 2 yr; 26 (9.7%) patients were categorized as Unable to CPET, 69 (25.7%) Unfit and 174 (64.7%) Fit. There were statistically significant differences between the three groups in hospital stay [median (IQR) 14.0 (10.5-23.8) vs 9.9 (5.5-15) vs 7.1 (4.9-10.8) days, P < 0.01] and mortality at 2 yr [11/26 (42%) vs 14/69 (20%) vs 19/174 (11%), respectively (P < 0.01)] although the differences between Unable and Unfit were not statistically different. CONCLUSIONS: Patients' inability to perform CPET is associated with inferior outcomes after major colorectal surgery. Future studies evaluating CPET in risk assessment for major surgery should report outcomes for this subgroup

Photoproduction of eta mesons from the neutron: cross sections and double polarization observable E

Photoproduction of $\eta$ mesons from neutrons} \abstract{Results from measurements of the photoproduction of $\eta$ mesons from quasifree protons and neutrons are summarized. The experiments were performed with the CBELSA/TAPS detector at the electron accelerator ELSA in Bonn using the $\eta\to3\pi^{0}\to6\gamma$ decay. A liquid deuterium target was used for the measurement of total cross sections and angular distributions. The results confirm earlier measurements from Bonn and the MAMI facility in Mainz about the existence of a narrow structure in the excitation function of $\gamma n\rightarrow n\eta$. The current angular distributions show a forward-backward asymmetry, which was previously not seen, but was predicted by model calculations including an additional narrow $P_{11}$ state. Furthermore, data obtained with a longitudinally polarized, deuterated butanol target and a circularly polarized photon beam were analyzed to determine the double polarization observable $E$. Both data sets together were also used to extract the helicity dependent cross sections $\sigma_{1/2}$ and $\sigma_{3/2}$. The narrow structure in the excitation function of $\gamma n\rightarrow n\eta$ appears associated with the helicity-1/2 component of the reaction

Comparison of risk-scoring systems in the prediction of outcome after liver resection

Background: Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study compares the utility of these techniques along with the number of segments resected as predictive tools in liver surgery. Methods: A review of a unit database of patients undergoing liver resection between February 2008 and January 2015 was undertaken. Patient demographics, ASA, CCI and CPET variables were recorded along with resection size. Clavien-Dindo grade III–V complications were used as a composite outcome in analyses. Association between predictive variables and outcome was assessed by univariate and multivariate techniques. Results: One hundred and seventy-two resections in 168 patients were identified. Grade III–V complications occurred after 42 (24.4%) liver resections. In univariate analysis of CPET variables, ventilatory equivalents for CO2 (VEqCO2) was associated with outcome. CCI score, but not ASA grade, was also associated with outcome. In multivariate analysis, the odds ratio of developing grade III–V complications for incremental increases in VEqCO2, CCI and number of liver segments resected were 1.09, 1.49 and 2.94, respectively. Conclusions: Of the techniques evaluated, resection size provides the simplest and most discriminating predictor of significant complications following liver surgery

The assessment of interpretation of test results in laboratory medicine

Sve je veća potreba za laboratorijskim stručnjacima koji mogu pružiti savjete o tumačenju rezultata, što obično čine dodavanjem kratkih napomena na nalazu. Iznenađujuće je koliko je malo podataka temeljenih na dokazima dostupno za tumačenje rezultata laboratorijskih pretraga. Kratke napomene koje prate laboratorijske nalaze su kompleksne te se obično sastoje od nekoliko sastavnica kojima se mogu predložiti moguće dijagnoze i dodatne pretrage. Svaka je takva napomena različita i procjena tumačenja nije jednostavna. U ovom ćemo članku govoriti o različitim mogućim pristupima: procjeni cijele napomene, samo nekih njenih sastavnica ili ključnih riječi, te sudjelovanju nezavisnog procjenitelja ili skupine stručnjaka. Niti jedan se pristup ne može smatrati zlatnim standardom, budući da procjena predstavlja nesavršenu znanost te je kao takva samo smjernica, a ne definicija jedinstvenih rješenja. Iako programi vanjske procjene kvalitete (engl. External Quality Assurance Schemes, EQAS) ispituju tumačenje rezultata te na taj način pružaju sudionicima programa informaciju o tome kakve su njihove napomene u usporedbi s drugima, primarna je svrha tih programa ipak obrazovna i, što je još bitnije, ti nam programi pomažu u prikupljanju spoznanja o tome kako poboljšati i razviti tumačenje.There is a growing need for laboratory professionals to o\u27er advice on the interpretation of results, typically by adding a brief interpretative comment to a report. Surprisingly little evidence-base data exists to support interpretation of laboratory test results, and interpretative comments accompanying laboratory reports are complex, usually consisting of several components which may suggest possible diagnoses and additional investigations. Every comment is different, and assessment of interpretation is difficult. We report different approaches that can be used: assessing whole comments or comment components or key phrases; and using independent assessors or a pooled panel of experts. No approach can be considered to be a \u27gold standard\u27 since assessment is an imperfect science and is a guide to, not a definition of unequivocal solutions. Although External Quality Assurance Schemes examining interpretation provide information to individual participants on how their comments compare with others, their primary purpose is educational, and even more importantly, these Schemes enable us to gather knowledge on how to better establish and develop interpretation

First measurement of the helicity asymmetry for γp→pπ0\gamma p\rightarrow p\pi^0 in the resonance region

The first measurement of the helicity dependence of the photoproduction cross section of single neutral pions off protons is reported for photon energies from 600 to 2300\,MeV, covering nearly the full solid angle. The data are compared to predictions from the SAID, MAID, and BnGa partial wave analyses. Strikingly large differences between data and predictions are observed which are traced to differences in the helicity amplitudes of well known and established resonances. Precise values for the helicity amplitudes of several resonances are reported

Struggles over access to the Muslim public sphere: Multiple publics and discourses on agency, belonging and citizenship (Introduction to the Themed Section)

Abstract This introductory essay provides the context for the articles in this Themed Section. Despite the diversity in locations, historical backgrounds and contemporary processes of change, all contributors to this Themed Section focus on the struggle of Muslim groups over access to an emergent Muslim public sphere. They highlight the contestations of and shifts in the notions of agency, belonging, and citizenship in nation-states with Muslim communities within its borders. The introduction consists of two parts. The first part reviews the notion of the public sphere as conceptualized by Habermas and critiqued by scholars of a diversity of backgrounds. In relation to the concept of the Muslim public sphere, three aspects of critique are given closer c

Robust End-to-End Hand Identification via Holistic Multi-Unit Knuckle Recognition

In many cases of serious crime, images of a hand can be the only evidence available for the forensic identification of the offender. As well as placing them at the scene, such images and video evidence offer proof of the offender committing the crime. The knuckle creases of the human hand have emerged as an effective biometric trait and been used to identify the perpetrators of child abuse in forensic investigations. However, manual utilization of knuckle creases for identification is highly time consuming and can be subjective, requiring the expertise of experienced forensic anthropologists whose availability is very limited. Hence, there arises a need for an automated approach for localization and comparison of knuckle patterns. In this paper, we present a fully automatic end-to-end approach which localizes the minor, major and base knuckles in images of the hand, and effectively uses them for identification achieving state-of-the-art results. This work improves on existing approaches and allows us to strengthen cases further by objectively combining multiple knuckles and knuckle types to obtain a holistic matching result for comparing two hands. This yields a stronger and more robust multi-unit biometric and facilitates the large-scale examination of the potential of knuckle-based identification. Evaluated on two large landmark datasets, the proposed framework achieves equal error rates (EER) of 1.0-1.9%, rank-1 accuracies of 99.3-100% and decidability indices of 5.04-5.83. We make the full results available via a novel online GUI to raise awareness with the general public and forensic investigators about the identifiability of various knuckle regions. These strong results demonstrate the value of our holistic approach to hand identification from knuckle patterns and their utility in forensic investigations

Demonstrable and anatomy-driven knuckle identification via crease map segmentation

Images of the human hand can be effectively deployed to assist with the identification of the perpetrators of serious crimes. One of the prominent and distinguishing features of the human hand is found in the skin of the finger knuckle regions, which includes creases forming complex and distinctive patterns. Exploiting knuckle skin crease patterning in the identification of perpetrators requires manual labelling from expert anthropologists, which is both laborious and time-consuming. Existing approaches for automatic knuckle recognition work in a black-box manner without explicitly revealing the causes of a match or no match. Whereas, the court-room proceedings demand a more transparent and reproducible matching procedure driven from anatomy and comparison of skin creases. Hence, development of automated algorithms to segment (trace) the knuckle creases and compare them exclusively can make the whole process demonstrable and convincing. This paper proposes an effective framework for knuckle crease identification that can directly work on full hand dorsal images to (i) localize the knuckle regions effectively, (ii) segment (trace) the knuckle creases and (iii) effectively compare knuckles through the segmented crease maps. The novel matching of knuckle creases is achieved through explicit comparison of the creases themselves and is investigated with a large public dataset to demonstrate the potential of the proposed approach

Comparison of the pharmacodynamic profiles of a biosimilar filgrastim and Amgen filgrastim: results from a randomized, phase I trial

Further to the patent expiry of Neupogen® (Amgen filgrastim), Hospira has developed a biosimilar filgrastim (Nivestim™) that may offer a clinically effective alternative for multiple hematologic and oncologic indications. Here results are reported from a phase I trial, primarily designed to compare the pharmacodynamic profiles of Hospira filgrastim and Amgen filgrastim. A phase I, single-center, double-blind, randomized trial was undertaken to demonstrate equivalence of the pharmacodynamic characteristics of Hospira filgrastim and Amgen filgrastim. Fifty healthy volunteers were randomized to receive 5 or 10 µg/kg dosing, before further randomization to treatment sequence. All volunteers received five daily subcutaneous doses of Hospira filgrastim or Neupogen, with subsequent crossover to the alternative treatment. Bioequivalence was evaluated by analysis of variance; if the estimated 90% confidence intervals (CIs) for the ratio of ‘test’ to ‘reference’ treatment means were within the conventional equivalence limits of 0.80–1.25, then bioequivalence was concluded. Forty-eight volunteers completed the study. Geometric mean absolute neutrophil count area under the curve from time 0 to the last time point at day 5 (primary endpoint) was comparable in volunteers given Hospira filgrastim or Amgen filgrastim at 5 µg/kg (ratio of means, 0.98; 90% CI, 0.92–1.05) or 10 µg/kg (ratio, 0.97; 90% CI, 0.93–1.01); 90% CIs were within the predefined range necessary to demonstrate bioequivalence. Hospira filgrastim was well tolerated with no additional safety concerns over Amgen filgrastim. Hospira filgrastim is bioequivalent with Amgen filgrastim with regard to its pharmacodynamic characteristics